不同手术入路治疗肱骨远端冠状面骨折的临床疗效观察  

Clinical observation of different surgical approaches for the treatment of distal humerus coronal fracture

作　　者：冷昆鹏 孟钰童 单磊[1] 刘洋[1] 周君琳[1] Leng Kunpeng;Meng Yutong;Shan Lei;Liu Yang;Zhou Junlin(Department of Orthopedics,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,100020

出　　处：《中华肩肘外科电子杂志》2024年第2期127-134,共8页Chinese Journal of Shoulder and Elbow(Electronic Edition)

基　　金：国家自然科学基金资助项目(82272469);北京市自然科学基金资助项目(7234371);北京市临床重点专科项目经费资助(BJYQFZ-2022)。

摘　　要：目的观察外侧、前外侧和后侧尺骨鹰嘴截骨入路治疗肱骨远端冠状面骨折的临床疗效,探讨不同骨折类型选择手术入路的适应证及注意事项。方法选取2010年1月至2023年1月本院收治的23例肱骨远端冠状面骨折患者作为研究对象,按照不同手术入路分为外侧、前外侧和后侧尺骨鹰嘴截骨入路组,临床疗效观察包括手术时间、切口长度、出血量、骨折愈合时间、肘关节活动度、前臂旋转、Mayo肘关节评分(Mayo elbow performance score,MEPS)、视觉模拟评分(visual analogue scale,VAS)和并发症等。结果共23例患者,平均年龄(48.9±17.0)岁,平均受伤至手术时间(5.1±2.0)d,平均随访时间(18.4±5.4)个月。三组患者的受伤原因和骨折改良Dubberley分型的比较,存在显著性差异。三组患者在手术时间、骨折愈合时间、前臂旋前、前臂旋后、MEPS和VAS评分的结果比较,差异无统计学意义。截骨组与外侧组在出血量、切口长度、肘关节屈曲、伸直和活动度的比较,差异具有统计学意义。截骨组患者切口较长、手术出血量较多、肘关节活动度的恢复较差,截骨组和前外侧组、外侧组和前外侧组在这几项结果的比较,差异无统计学意义。结论外侧、前外侧和后侧尺骨鹰嘴截骨入路治疗肱骨远端冠状面骨折具有不同的适应证,应根据骨折类型选择合适的入路,适合截骨入路的骨折更复杂,功能锻炼应更加关注肘关节屈伸活动的恢复。Background Distal coronal humerus fractures are relatively rare in clinical practice,accounting for only 6%of distal humerus fractures and 1%of elbow fractures.With this type of fracture involving the humeral head or trochlea,anatomic reduction and firm fixation of the ulnar and radio-radial articular surfaces are essential to achieve satisfactory recovery of elbow motion.The mechanism of injury is mainly due to the axial load imposed on the distal humerus by the force transmitted through the joint,resulting in a coronal shear fracture of the capitulum or trochlea.About 60%of distal humerus coronal fractures are associated with radial head fracture or ulnar tract injury of lateral collateral ligaments.While the integrity of the ligaments is equally essential for the recovery of elbow function,the attachment of the lateral collateral ligaments makes the fracture reduction and fixation of the distal posterior condyle of the humerus more difficult.Surgical treatment of distal humeral coronal fracture includes fracture mass excision,open reduction,internal fixation,arthroscopic assisted reduction and fixation,elbow joint replacement,etc.Surgical approaches mainly include lateral,anterolateral,and posterior olecranon osteotomy approaches.Given the complexity of the distal humeral coronal fracture,surgical exposure and fixation methods are controversial.Surgical treatment is highly challenging.Objective To observe the clinical effect of lateral,anterolateral,and posterior olecranon osteotomy approaches in treating distal humeral coronal fracture and to explore the indications and precautions of different fracture types.Methods Twenty-three patients with distal humerus coronal fractures admitted to our hospital from January 2010 to January 2023 were selected as the study objects and divided into lateral,anterolateral,and posterior olecranon osteotomy groups according to different surgical approaches.The clinical effects were observed,including operation time,incision length,blood loss,fracture healing time,Elbow motion,

关 键 词：肱骨远端冠状面骨折 手术入路 内固定治疗 肘关节功能 

分 类 号：R687.3[医药卫生—骨科学]